Camp Lejeune Family Member Program - Treating Physician Report

Give your physician a copy of the blank VA Form 10-10068a and explain: (1) You lived at Camp Lejeune between 1953-1987, (2) You believe your condition (list it) is covered under the CLFMP program, (3) VA needs a physician's confirmation of the diagnosis and clinical details. Your doctor needs to: state the diagnosis, provide the date of first diagnosis, describe the current clinical status, and sign.

(patient coaching notes for doctor appointment)

Common mistakes

• ×Not bringing a blank form to the appointment - most physicians have never seen this form before and will need it.
• ×Expecting the physician to know about CLFMP - most do not; be prepared to explain.

The physician must document: (1) ICD-10 diagnosis code and description, (2) Date first diagnosed, (3) Current treatment status and medications, (4) Whether the condition is ongoing or in remission, (5) Current functional limitations. The physician should also sign and date with their license number, NPI, and contact information.

(review with your physician)

Common mistakes

• ×Physician completing the form without the patient's CLFMP application number - include your case number on the top of the form before giving it to the doctor.

Authority

• 38 CFR 17.400 - 15 covered conditions for family members at Lejeune 1953–1987.